THE BASIC PLAN

So what are the basics of Part "D" - -(Part D is the Medicare Prescription Drug program)? The bill signed by President Bush is 411 pages long, and takes a CIA decoding team to understand. Do we dare try to summarize it on one page?

Since 2006, Medicare Part D offers some help with prescription drugs. The coverage is voluntary, handled by private insurance companies, and the monthly premium varies depending on how much coverage you have. You can get the part D benefit in a policy that is considered a "stand alone" (covers only drugs), or in a Medicare Advantage plan which incorporates Medicare Parts A, B, and D in one policy (and is sometimes called Medicare Part C).. For a more complete description of Part D, as well as other prescription drug  information and links, see, SeniorArk Main Medicare Page, Charts,  Fiasco, and the Donut Hole.

Under Medicare Part D, private insurance companies (Prescription Drug Plans, called PDPs, or existing Medicare Choice plans, which will be renamed Medicare Advantage plans) will enter into contracts with the Department of Health and Human Services to provide insurance for prescription drugs. The coverage and requirements, such as use of formulary drugs, under the plans will vary by region to reflect differences in provider costs and patient demo- graphics. In 2006, first year of the program, the premium averaged $35 a month ($420 a year). In my area there are 55 Prescription Drug Plans for 2010. Premiums range from $16.70 to $110.70. Most have no coverage in the gap, or "donut hole". Those that do cover the donut hole, offer only some or all generics, except for one that covers a few branded drugs. Premiums for these 55 plans seem to be averaging about $50 per month .  

To assess what is best for you, talk with a senior representative in your state. There are folks employed to do this very thing. Or go to www.medicare.gov.

Summary of Part D (Prescription Drug Program) for 2010 

Medicare Part D prescription drug coverage will change in 2010. First, the deductible amount increases from $295 to $310. Then the initial coverage limit to reach the donut hole  increases from $2,700 to $2830 (deductible + initial coverage section). Then the next $3610 is to be paid from your pocket (donut hole, no Medicare participation). If you are unfortunate enough to need more than $6440 in drugs ($2830 + $3610) during the calendar year, you enter what is called "Catastrophic Coverage". In this category, you will pay $2.40 for generics, and either 5% or $6.30 for brand names--whichever is higher.

Remember, these are the general Part D guidelines. Depending on the insurance provider you select, and the premium you pay, you may experience variations.

Part D enrollees may be eligible for more help if there has been a change in income status, such as from lost income, retirement or disability. The time to change plan coverage is Nov. 15 to Dec. 31.

During October all companies with Plan D coverage began sending marketing materials for 2009. Also during October, information will be sent about termination for Part D coverage in 2009 and co-payment levels for beneficiaries who continue to qualify but whose co-payment will change.

As a place to start, try this link to see if you might qualify for additional help with Part D. You may find additional help available from your state's programs. More on that in the next paragraph.

Many mailings may be difficult to understand. I know mine are. A Social Security representative suggested to me today that we should discuss our Part D plans with a state representative who is qualified to help us with our options. (My first choice) Go to the SeniorArk "Government Links" page, click your state on the map, and locate someone who can direct you to the correct person. This is very important, since they have studied the programs of the many insurers, are aware of changes in the programs, and can tell you if you qualify for additional state help with prescription cost. You don't need to be poor to qualify for this help in many states. You can also go to our SeniorArk "Medicare Tips" page where you can click on your state from a list. This will show you the Part D insurer plans that are available in your state, but you still need to find a qualified state representative to help you decide. Don't just talk with insurance company representatives about you decision. They are salespeople. You need a detached advisor who does not stand to gain financially from your decision.

As another option, the Social Security representative suggested a talk with your pharmacist. Competition between major pharmacies is intense for the Senior Part D business. As a result, many are training their pharmacists to help guide you through the maze of deciding on the program that is best for you. Many of these folks may be more informed than the state people.. But the state representatives are important, since they  may better understand whether you qualify for additional help. These folks can be very helpful, but you would still be well-advised to seek out a state or Medicare employee for advice.

 This is how Part D looks in Chart Form : 2010